Obstetric emergencies during labour (maternal collapse, sepsis, shoulder dystocia)

Question 1

What is prolonged rupture of membranes?

Answer 1

Over 18 hours between ROM and delivery

Question 2

What is maternal collapse?

Answer 2

Any event involving the cardiorespiratory system and/or brain, causing a reduced or absent conscious level or death, at any stage during the pregnancy and up to 6 weeks after delivery

Question 3

What causes maternal collapse?

Answer 3

Haemorrhage (often concealed)
VTE
Amniotic fluid embolism
Cardiac disease (MI, aortic dissection, cardiomyopathy)
Sepsis (have high index of suspicion)
Drug toxicity
Eclampsia
Intracranial haemorrhage
Trauma

Question 4

What organisms commonly cause sepsis in pregnant women?

Answer 4

Group A, B, D strep
Pneumococcus
E. Coli

Question 5

What are the risk factors for maternal sepsis?

Answer 5

Obesity, diabetes, immunosuppresion anaemia, vaginal discharge, PROM, invasive procedures, minority ethnic groups, PMH of pelvic infection

Question 6

How is maternal sepsis managed?

Answer 6

SEPSIS 6 - same as normal patient

Question 7

What is amniotic fluid embolus?

Answer 7

When amniotic fluid, foetal cells, hair, other debris enters maternal bloodstream via placenta, causing a reaction similar to anaphylaxis
Prerequisites:
- Ruptured membraines
- Ruptured cervical veins
- Pressure gradient from uterus to veins

Question 8

What are the symptoms of amniotic fluid embolus?

Answer 8

1st phase - acute SOB, hypotension, circulatory collapse

2nd phase - excessive bleeding, foetal distress and death

Question 9

How is maternal collapse managed?

Answer 9

Assess patient with TABC approach:
T: Tilt - tilt mother 15 degrees to the left to relieve pressure on uterus and promote efficient CPR

A: Airway - intubate with cuffed endotracheal tube (increased risk of aspiration in pregnancy)

B: Breathing - give 100% high flow 02 immediately (as mother is more at risk of hypoxia)

C: Circulation - give fluids in case of haemorrhage, angled chest compressions

Question 10

If no response to CPR after 4 mins and baby >20 weeks, what do you do?

Answer 10

EMERGENCY C-SECTION - however the mother’s life is more important than the baby

Question 11

What is the common consequence of shoulder dystocia?

Answer 11

Erbs palsy of the brachial plexus (50%)

Question 12

What is shoulder dystocia?

Answer 12

When additional manoeuvres are required after normal downward traction has failed to deliver the shoulders after the head has delivered

Question 13

What are the risk factors for shoulder dystocia?

Answer 13

• Macrosomia
• Previous shoulder dystocia
• Increased maternal BMI
• Labour induction
• Maternal diabetes
• Instrumental delivery

Question 14

How is shoulder dystocia managed?

Answer 14

Gentle downward traction with McRoeberts manoeuvre (legs hyperextended onto the abdomen)

Question 15

When should foetal scalp monitoring be used?

Answer 15

If there are signs of foetal distress on CTG (decreased variability, lowered baseline, decelerations)

Question 16

In which cases should an emergency c-section be considered?

Answer 16

• Fetal distress (pH <7.20 on fetal scalp monitoring)
• APH
• Failed instrumental delivery

Question 17

What are the 4Hs, 4Ts and E?

Answer 17

The reversible causes of maternal collapse:
Hypovolaemia, hypoxia, hypo/hyperkalemia, hypothermia
Thromboembolism, toxicity, tension pneumothorax, tamponade
Eclampsia